What is coeliac disease?
If you have recently been diagnosed with coeliac disease, don’t panic! – here are answers to the most commonly asked questions, along with advice on what to eat and what to avoid. Coeliac (pronounced seeliac and spelt Celiac in America) disease is often misunderstood. It is frequently regarded as an allergy or simple food intolerance, but it is actually a lifelong auto-immune disease affecting the gut and other parts of the body. When people with coeliac disease eat gluten, their immune system reacts damaging the lining of the gut and this makes it difficult to absorb nutrients from food. Gluten gives bread its elasticity and cakes their spring. It is a protein found in cereals such as wheat, barley and rye. Oats may also affect some people.
The small intestine is lined with small, finger-like projections called villi. These play a crucial role in digestion, as they increase the surface area of the small intestine and allow essential nutrients to be absorbed into the bloodstream. However, for people with coeliac disease, when gluten comes into contact with the villi, it triggers a response by the immune system, which attacks the villi. The villi very quickly become damaged and inflamed and therefore key nutrients are not absorbed from any food we eat. This results in a range of nutritional problems and symptoms with varying severity.
What are the symptoms?
There are a variety of gastrointestinal symptoms such as cramps, bloating, flatulence and diarrhoea. It is quite common for these to be confused with irritable bowel syndrome (IBS) and only later to be identified as coeliac disease. Research shows that 1 in 100 people in the UK have coeliac disease but only a quarter of them are currently diagnosed.
Typical symptoms of coeliac disease
The symptoms vary in terms of severity. Most stem from the malabsorption of nutrients, and include diarrhoea, fatigue and iron deficiency, but there is a range of other symptoms, such as:
- Abdominal pains
- Weight loss (but not in all cases)
- Mouth ulcers
- Hair loss
- Skin rash
- Defective tooth enamel
- Problems with fertility
- Recurrent miscarriages
Diarrhoea is a common symptom. Yet it is important to note that sufferers can present many and varied symptoms: some may have a normal bowel habit or even tend towards constipation, children may not gain weight or grow properly, while adults may find they lose weight. Malabsorption may also leave people tired and weak, due to anaemia caused by iron deficiency.
In fact, rather than suffering from bowel problems, some people with coeliac disease approach their doctor because of extreme tiredness (due to chronic, poor iron absorption) and psychological problems such as depression. There can also be a malabsorption of calcium, resulting in low bone density and sometimes even fractures (as a result of osteoporosis). Bone and muscle pain can also be a problem. Ulcers in the mouth or a blistering, itchy skin rash, mostly on the elbows and knees (called dermatitis herpetiformis), are also symptoms of coeliac disease.
Undiagnosed coeliac disease can result in infertility in both men and women and there is also an increased risk of miscarriage.
How do I get diagnosed?
First, if you suspect you may have coeliac disease, don’t worry! Just remember, it is entirely manageable with a controlled diet. In fact, if you are one of the many undiagnosed people with coeliac disease you’ll probably be pleased to find out that you really do have a condition and, better yet, that there is a course of action to make you well again.
There is a clear procedure for diagnosing coeliac disease. The first thing to do is talk through your symptoms with your doctor, who can perform a simple blood test. This test looks for antibodies, which your body produces in response to gluten. It is essential to follow your normal gluten containing diet leading up to the test, as you need to have the antibodies in your blood for a test to work, and these will only be there if you have been eating gluten. It is quite common for people to go undiagnosed if they have followed a gluten-free diet for days or weeks, as the immune system will be producing fewer antibodies. This will give a false, negative result to the test. To get an accurate result it is important to consume food that contains gluten in at least one meal a day, for a minimum of six weeks, before a blood test.
If the test is positive, it is recommended that people then have an intestinal biopsy, which examines the appearance of the villi in the small intestine, under a microscope, to check for damage.
This will confirm the diagnosis, which you need before you start on a lifelong gluten-free diet. Again, the biopsy of the small intestine must be done whilst you’re following a gluten containing diet. If you are already following a gluten-free diet when you have your biopsy, it might show a completely normal intestinal lining or you may have an inconclusive result.
What is the treatment?
Coeliac disease is treated with a gluten-free diet, so wheat, barley, rye and any derived ingredients must all be avoided. The most obvious sources of gluten in the diet are pastas, cereals, breads, flours, pizza bases, pastry, cakes and biscuits. Oats can often be contaminated with other grains, and although most people are able to tolerate uncontaminated oats without a problem, some people with coeliac disease may be sensitive and should avoid them. Uncontaminated oats are available but should be tried under supervision of your healthcare team.
Following a strict gluten-free diet allows the intestines to heal and begins the alleviation of symptoms in most cases. Depending on how early on the gluten-free diet is started, it can also eliminate the increased risk of osteoporosis and cancer of the small bowel.
What can I eat?
There are plenty of foods that are naturally gluten-free and should be included in your diet. In particular, carbohydrate-rich foods such as potatoes, rice and maize do not contain gluten. All fresh meat, poultry and fish, all fresh fruit and vegetables, fresh herbs, individual spices, dried pulses, rice noodles, potatoes, plain nuts, eggs, dairy products, sugar, honey, oils and vinegars, vanilla essence and extract and fresh and dried yeast are suitable. In fact, the gluten-free diet has the potential to be one of the healthiest diets around because of the increased emphasis placed upon eating fresh, natural and unprocessed food. If undiagnosed coeliac disease has resulted in the poor absorption of vitamins and minerals, a gluten-free diet should soon restore these to healthy levels and lead to a feeling of health and wellbeing.
More and more manufacturers are producing gluten-free substitute foods, such as gluten-free bread, crackers and pasta, some of which can be just as good as their gluten-containing equivalents. Coeliac UK the national charity for people with coeliac disease publishes a Food and Drink Directory annually, which is a list of nearly 10,000 gluten-free products.
Gluten -Free Foods
- All fresh meat and fish
- All fresh fruit and vegetables
- Fresh herbs and individual spices
- Polenta (ground cornmeal or maize)
- Dried peas, lentils, pulses and beans
- Rice and wild rice
- Rice bran
- Rice noodles
- Plain nuts and seeds
- Dairy products – milk, cream, natural yogurt, cheese
- Soya and plain tofu
- Golden syrup
- Maple syrup
- Jams and marmalade
- Pure oils and fats
- Tomato purée
- Vanilla essence and extract
- Fresh and dried yeast
What about contamination?
The tiniest amount of gluten can cause problems for people with coeliac disease. Dry gluten-containing ingredients like flour and breadcrumbs are high-risk ingredients for contamination and cross-contamination when you are producing gluten-free meals. It is a good idea to keep gluten-free foods separate in the kitchen to make sure you avoid contamination with gluten from other foods.